Medicare and Medicaid at 50

For most Americans today, Medicare and Medicaid have been in existence all their lives. A recent Kaiser Family Foundation poll, conducted in Spring 2015 in honor of the 50th Anniversary of the enactment of Medicare and Medicaid, found that most adults find both programs to be very important, and more than eight in ten people covered by Medicare and Medicaid say they feel well-protected financially by their health insurance coverage.

While there are still elderly, disabled, and low-income individuals who face financial risk from health expenses, the nation has come a long way in the 50 years since President Lyndon B. Johnson signed into law the sweeping provisions establishing both the Medicare and Medicaid programs, thereby increasing the security and health of some of the nation’s most vulnerable populations.

The wide-ranging impact of Medicare and Medicaid is evident throughout NLM’s various collections and resources—from PubMed citations for the current literature, to documents, images, and interviews in the History of Medicine collection, to health services research projects-in-progress included in the Health Services Research Projects in Progress (HSRProj) database, to terminology and value sets needed to bring about meaningful use of electronic health records—all richly reflect and support the significance and scope of the Medicare and Medicaid programs.

Establishment of a national healthcare system had been a subject of debate in the U.S. since early in the 20th century. President Teddy Roosevelt had included it in his campaign platform in 1912 but was unable to make it a reality. President Harry S. Truman pushed it in 1945, but the bill brought to Congress could not be passed in the face of staunch resistance from the American Medical Association and other groups. Such proposals were branded as attempts to achieve “socialized medicine,” a term of opprobrium in the post-war climate of Cold War America. But the facts remained: in the open market, insurance companies saw the elderly population as high risk. Premiums were expensive, much higher than for younger people, and impoverished populations could not afford either health care or insurance premiums. Labor unions, which were the main advocates for Truman’s proposals, focused their attention on fighting for health benefits from employers, further tying insurance coverage to the younger, working populations and excluding the retired, the unemployed, and the lowest paid workers. In 1960, a program of Federal grants to states to support need-based medical assistance for the elderly was enacted; called “Kerr-Mills” for its chief sponsors, its implementation was limited.

Senior citizens demonstrate their support of Medicare, 1964 National Library of Medicine #A033437

A Senior citizen demonstrates her support of Medicare and Lyndon Johnson at the 1964 Democratic National Convention, 1964 National Library of Medicine #A033438

First as Senator and then as President, John F. Kennedy took up the cause. In his State of the Union Message of January 14, 1963, and in subsequent special messages to Congress specifically on the topic, President Kennedy urged the new Congress to enact a program of health insurance for the aged under the Social Security Act. Legislation again languished, but in the months after his election following Kennedy’s assassination, President Johnson, found popular support for his Great Society agenda and urged Congressional colleagues, such as powerful House Ways and Means Chairman Wilbur Mills, to move quickly to enact the desired legislation.

A dramatic contemporaneous summary and legislative history of the Social Security Act Amendments of 1965 was released in September of that year, written by Wilbur J. Cohen, Under Secretary of Health, Education, and Welfare and Robert M. Ball, Commissioner of Social Security, both of whom had been instrumental in the crafting of the legislation. Speaking of the Medicare provisions in particular, Cohen and Ball wrote:

“The Social Security Amendments of 1965 embody the most far-reaching social security legislation to be enacted since the original Social Security Act was passed 30 years earlier. The law closes one of the major gaps in the economic security of the elderly by providing protection against the high costs of hospital and medical care…”

The Social Security Amendments of 1965 were signed into law on July 30, 1965 in Independence, Missouri where President Lyndon Johnson had moved the event in order to specially honor President Harry Truman. In his signing speech Johnson spoke movingly of the privations of age and poverty, of Truman’s vision, and of the hard work of his colleagues in Congress and elsewhere who had made the vision a reality.

“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully, put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.”

Johnson also spoke of reaching out to the medical profession, in order to begin to shift the focus in the country from the law’s enactment to its implementation, with first payments under Medicare, for example, slated for a scant 12 months later. The Medicare and Medicaid programs have been amended and extended over the past 50 years, most notably in expanding the populations served and including prescription benefits, and they have had a profound impact on access, cost and quality of care, as well as on the achievement of related goals, such as enforcement of the Civil Rights Act.

Lisa Lang is Assistant Director for Health Services Research Information at the National Library of Medicine (NLM) and Head of its National Information Center on Health Services Research and Health Care Technology (NICHSR). Thanks to NICHSR Librarian Patricia Gallagher for helping to identify materials in the NLM collection for this post.